Identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing. Actively engages and coordinates with other team members to maintain a positive, collaborative relationship. Works under close supervision.
Receives and responds to incoming calls or faxes from providers, referral sources, and potential patients. • Accurately enters information to begin the referral process into the CareCentrix portal and accurately records the outcome of calls in the proper screen. • Collects and enters clinical and demographic information to begin the referral process along with verifying eligibility and benefits information by contacting health plans or payors to ensure services provided will be covered by the carrier. (e.g., deductible amounts, co-payments, effective date, pre-existing clauses, levels of care, authorization, visit limitations, documentation required to process claims, etc.). • Accurately documents all communications and decisions into a computer database. • Consults applicable Payer Fact Sheets in Intake Process. Works with other staff and patients to identify potential solutions as problems are identified with payer sources. • Identifies potential payer sources, obtains authorization from the authorizing entity. Accurately documents conversations and decisions with payer sources • Processes SV Alerts and communicates resolution to the quality team and the patient. • Responsible for logging all interactions and thoroughly following up with members and providers. • Files CARTs, completes the Internal Issue Log, and SOC templates when applicable.
Requires a HS diploma or equivalent; up to 1 year of previous related experience; or any combination of education and experience, which would provide an equivalent background. • One year billing, insurance or claims experience. • The ability to effectively multi-task. • Medical terminology, insurance verification or healthcare experience preferred. • Must be proficient and comfortable in a computer-based environment.